Provider Demographics
NPI:1013257880
Name:TEAM DENTAL SWEDESBORO, LLC
Entity type:Organization
Organization Name:TEAM DENTAL SWEDESBORO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MURTUZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-467-4677
Mailing Address - Street 1:300 LEXINGTON RD
Mailing Address - Street 2:BUILDING B, SUITE 220
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1278
Mailing Address - Country:US
Mailing Address - Phone:856-467-4677
Mailing Address - Fax:856-832-4173
Practice Address - Street 1:300 LEXINGTON RD STE 220
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1278
Practice Address - Country:US
Practice Address - Phone:856-467-4677
Practice Address - Fax:856-832-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01454700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty